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Submitted: 09 February 2017 Modified: 20 March 2017
HERDIN Record #: NCR-PHC-17020915114639

A proposed Pediatric Risk Stratification Method (PediaRiSM) for post operative pulmonary complication for cardiothoracic surgery.

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Background: Pulmonary complications are the most common form of postoperative morbidity experienced by a pediatric patient undergoing surgery, particularly cardiothoracic surgery. There has been no preoperative risk stratification method available to evaluate pediatric patients. This study aimed to propose a risk stratification method for post-operative pulmonary outcomes among pediatric patients undergoing cardiothoracic surgery.


Methods: We retrospectively reviewed medical records of 506 children aged 6 to 19 years old who underwent cardiothoracic surgery from June 2003 to 2008. Preoperative risk factors extracted included age, gender, cardiothoracic anomalies, nutritional status, and co-morbidities. Laboratory data included complete blood count, 2D echocardiogram, chest radiograph, pulmonary function tests and blood gas analysis. These parameters were associated with pulmonary complications observed such as atelectasis, pleural effusion, pneumonia, pneumothorax, pulmonary edema and airway problem.--- We retrospectively reviewed medical records of 506 children aged 6 to 19 years old who underwent cardiothoracic surgery from June 2003 to 2008. Preoperative risk factors extracted included age, gender, cardiothoracic anomalies, nutritional status, and co-morbidities. Laboratory data included complete blood count, 2D echocardiogram, chest radiograph, pulmonary function tests and blood gas analysis. These parameters were associated with pulmonary complications observed such as atelectasis, pleural effusion, pneumonia, pneumothorax, pulmonary edema and airway problem.


Results: Three hundred thirty (65.2%) out of 506 children developed post-operative pulmonary complications with atelectasis (25.6%) being the most frequent complication observed. Among the clinical variables analyzed, only three variables were independently predictive of post-operative complications, namely: FVC of < 80 ( p=.030); blood pH of < 7.35 ( p=.024) and white blood cell count of > 12 T per cubic mm (p=.0001). ROC analysis derived the best minimum cut-off score of 11 points with a sensitivity of 88.8%, specificity of 85.1%, and positive likelihood ratio (LR+) of 5.41. The overall accuracy of the scoring index was 81.6% [ p=0.002].


Conclusion: Pre-operative risk stratification for pediatric patients undergoing cardiothoracic surgery using this scoring index is simple and rapid.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Semi-Annual
Publication Date
May-August 2012
Volume
16
Page(s)
34-46
LocationLocation CodeAvailable FormatAvailability
Philippine Heart Center Medical Library Fulltext Print Format